Department of Pediatrics, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Pediatr Cardiol. 2021 Feb;42(2):255-263. doi: 10.1007/s00246-020-02473-1. Epub 2020 Oct 13.
Fragmented QRS (fQRS) is an easily evaluated noninvasive parameter in electrocardiograms (ECGs) for predicting cardiac adverse events. Our study aimed to evaluate whether fQRS could be used as a risk factor to predict a major adverse cardiac event (MACE) in children with idiopathic dilated cardiomyopathy (DCM). Our retrospective study enrolled 63 patients aged ≤ 19 years who were newly diagnosed with idiopathic DCM at Samsung Medical Center from 2003 to 2014, and followed up until December 2018. Demographic data, ECGs, and echocardiography were reviewed and analyzed for their possible links with adverse outcomes. The median age was 14.0 months and the median length of follow-up was 65.0 months. Age, QRS duration, and ejection fraction in M-mode at diagnosis were significantly different between the fQRS and non-fQRS groups (P = 0.026; P = 0.001; and P = 0.020). Significant difference between the fQRS and non-fQRS groups was found in patients with a MACE (P = 0.016, odd ratio 3.643) or any arrhythmias (P = 0.008, odd ratio 6.563). The MACE-free survival rate showed a significant difference in terms of fQRS (P = 0.003; P = 0.007; and P = 0.027). In univariate analyses, age, QRS duration, corrected QT, positive fQRS, and the number of leads with fQRS were significant predictors of MACEs. Among the above factors, positive fQRS at diagnosis was a strongly significant predictor of adverse outcomes in multivariate analyses (hazards ratio 94.529, P = 0.001). Fragmented QRS complex at diagnosis could be used as a strong predictor for cardiac adverse outcomes in pediatric patients with idiopathic DCM.
碎裂 QRS 波（fQRS）是心电图（ECG）中易于评估的非侵入性参数，可用于预测心脏不良事件。本研究旨在评估 fQRS 是否可作为预测特发性扩张型心肌病（DCM）患儿发生主要不良心脏事件（MACE）的危险因素。本回顾性研究纳入了 2003 年至 2014 年期间在三星医疗中心新诊断为特发性 DCM 的 63 名年龄≤19 岁的患者，并随访至 2018 年 12 月。回顾性分析了人口统计学数据、心电图和超声心动图，以评估它们与不良结局的可能联系。fQRS 组和非 fQRS 组在年龄、QRS 时限和 M 型超声心动图射血分数方面存在显著差异（P=0.026；P=0.001；P=0.020）。在发生 MACE（P=0.016，优势比 3.643）或任何心律失常（P=0.008，优势比 6.563）的患者中，fQRS 组与非 fQRS 组之间存在显著差异。在 fQRS 组中，MACE 无事件生存率存在显著差异（P=0.003；P=0.007；P=0.027）。在单变量分析中，年龄、QRS 时限、校正 QT、阳性 fQRS 和有 fQRS 的导联数是 MACE 的显著预测因素。在上述因素中，诊断时阳性 fQRS 是多变量分析中不良结局的强预测因素（危险比 94.529，P=0.001）。在特发性 DCM 患儿中，诊断时出现碎裂 QRS 波复合波可作为心脏不良结局的有力预测指标。
